Jeffrey D. Sadow is an associate professor of political science at Louisiana State University Shreveport. If you're an elected official, political operative or anyone else upset at his views, don't go bothering LSUS or LSU System officials about that because these are his own views solely.
This publishes Sunday through Thursday with the exception of 7 holidays. Also check out his Louisiana Legislature Log especially during legislative sessions (in "Louisiana Politics Blog Roll" below).

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27.8.13

False narrative that past Cassidy bills resemble Obamacare

Being that Republican Senate candidate Rep. Bill Cassidy actually has practiced
medicine for a quarter century or so with a high volume of Medicaid patients,
as compared to his opponent Democrat Sen. Mary
Landrieu who has been in elected office almost from the day she graduated
college, it’s not surprising that during his short stint in the Louisiana
Legislature he authored a pair bills dealing with health care provision. But to
make any attempt to equate those two to the Patient Protection and Affordable
Care Act (“Obamacare”) that he now campaigns against demonstrates a distinct
lack of understanding both about the many flaws of Obamacare and therefore why
Cassidy opposes it.

In 2007, Cassidy introduced SB
307, which would have created a health care exchange run by the state,
designed for participating entities to buy and sell health insurance. Its
operation would be funded through own revenues (presumably a fee attached to
policies sold this way) and primarily was aimed at Medicaid recipients; in
those days, the state operated Medicaid as a fee-for-service arrangement where
providers performed whatever actual and presumed needed services in any way they
wanted then billed the state, no questions asked.

In 2008, he introduced SB
535, which would have changed from optional to a requirement that employers
of fewer than 50 offer specified mental health insurance benefits, and would
add on more if and when the state offered a tax credit equal to the premium
increase, if an employer offered health insurance. Neither bill was passed into
law.

Neither bill also resembles much Obamacare’s onerous and
counterproductive provisions. First, in the bills the only mandatory aspect was
the 50 or fewer requirement for mental health benefits if the employer offered
insurance. Individuals were not required to have insurance and to enter a
health exchange if they did not purchase it another way or face fines. What
makes Obamacare particularly noxious (besides being bad
policy authorized through bad jurisprudence) is it forces people to buy
something or penalizes them, violating their liberty. Nothing in Cassidy’s bills
argued for that: it did not require individuals to have insurance, nor for
employers to have to provide it.

Finally, SB 307 was aimed primarily at the state’s Medicaid program as
it then existed, where it directed the state to find ways to put its Medicaid
population into an exchange, using a premium support plan if found effective.
And, in large degree, that’s what happened since with the introduction of the
Bayou Health program that has transferred about three-quarters of Medicaid
clients into its managed capitation regime that in essence includes premium
support: the state provides funds to buy insurance from any of five plan
providers, and the administrators take it from there. This resulted in $135
million of savings last year. By contrast, Obamacare simply wished to
expand the Medicaid population without cost savings reforms, which Louisiana
correctly rejected.

So, contrary
to some media assertions, there’s not much similar between these bills and
Obamacare, and thus little that Cassidy or other Republicans would wish to
repeal that he endorsed in some fashion previously. Unlike Obamacare, Cassidy’s
bills never forced employers to offer a defined set of benefits and coverage,
except for the mental health ones for small employers already offering
insurance, never forced people to have insurance or to pay a penalty, never
mandated universal coverage set at community rates (that is, insurers could not
price actual risk into rates), and did not raise costs to taxpayers and
probably would have passed on just a small increase to those who voluntarily
used the exchange.

Republicans generally, and apparently Cassidy as well,
argue against Obamacare precisely because it raises costs on Americans while
reducing choices, empowering government at the expense of the people. Rather
than understand and accept this, proponents of Obamacare often try to make out
a straw man that opponents criticize it only because Democrats enacted “health
care reform” first. This inaccurately drives any implication that Cassidy
opposes something he once supported, and is used as a tactic to re-elect
Landrieu.

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